Heartburn Support - Stretta procedure feedback

Author

Stretta procedure feedback

tj1

2006-07-30, 2:21 am

Hello-

I'm 26 years old and have suffered from chronic GERD for the last 11
months. I am unable to tolerate any of the 5 PPI's, and H2 blockers do
not provide sufficient relief, and tend to give me horrible side
effects after about 10 days. I've undergone 24-hour PH testing,
another test that measures LES pressure, and have been diagnosed with
abnormal daytime reflux. My GI doc recommended the Stretta procedure,
but before scheduling it, I would like to hear about the experience of
someone who has undergone the procedure. Primarily, I would like to
know if it was effective, and weather there were any side effects or
not. The research I have done indicates that it is effective in
decreasing both symptoms of GERD and PPI/H2 blocker use for up to 5
years, possibly longer but data prior to 2000 doesn't exist. It does
look promising, but I wanted to get a personal perspective before
making a decision.

Thanks,
Travis

Howard McCollister

2006-07-30, 8:23 am

"tj1" <tjohnson01@gmail.com> wrote in message
news:1154237288.676857.288180@i3g2000cwc.googlegroups.com...
> Hello-
>
> I'm 26 years old and have suffered from chronic GERD for the last 11
> months. I am unable to tolerate any of the 5 PPI's, and H2 blockers do
> not provide sufficient relief, and tend to give me horrible side
> effects after about 10 days. I've undergone 24-hour PH testing,
> another test that measures LES pressure, and have been diagnosed with
> abnormal daytime reflux. My GI doc recommended the Stretta procedure,
> but before scheduling it, I would like to hear about the experience of
> someone who has undergone the procedure. Primarily, I would like to
> know if it was effective, and weather there were any side effects or
> not. The research I have done indicates that it is effective in
> decreasing both symptoms of GERD and PPI/H2 blocker use for up to 5
> years, possibly longer but data prior to 2000 doesn't exist. It does
> look promising, but I wanted to get a personal perspective before
> making a decision.
>

About 75% of patients undergoing Stretta will be able to stop their meds
within about 1 year after the procedure. It tends to be less effective in
patients with hiatus hernia, and in patients who have abnormally low resting
LES pressure. The side effects are minimal, the safety is quite high (in
competent hands). It's an outpatient procedure with very little pain and a
very quick return to normal activities. The postive effects of Stretta may
take 6 months to manifest themselves. It does not preclude other anti-reflux
procedures later if it doesn't work. There is little to lose and potentially
a lot to gain from the Stretta procedure.

HMc

Blocks to Books

2006-08-04, 9:24 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:44cc9581$0$74490$bb4e3ad8@newscene.com...
>
> "tj1" <tjohnson01@gmail.com> wrote in message
> news:1154237288.676857.288180@i3g2000cwc.googlegroups.com...
>
> About 75% of patients undergoing Stretta will be able to stop their meds
> within about 1 year after the procedure. It tends to be less effective in
> patients with hiatus hernia, and in patients who have abnormally low
> resting LES pressure. The side effects are minimal, the safety is quite
> high (in competent hands). It's an outpatient procedure with very little
> pain and a very quick return to normal activities. The postive effects of
> Stretta may take 6 months to manifest themselves. It does not preclude
> other anti-reflux procedures later if it doesn't work. There is little to
> lose and potentially a lot to gain from the Stretta procedure.
>
> HMc
>

I'm a different person from the poster above. I asked you some stretta
questions prompted by this poster's comments and your response to the
poster. Thank you for the answers you gave me. I now have one more big
concern:

If it is found that a person has a large hiatus hernia, low resting LES
pressure, and esophagitis, does that rule them out completely as a potential
stretta procedure candidate or does it make any success from the procedure
extremely unlikely?

Are there any non-proton pump inhibitor treatment options for a person with
a large hiatal hernia, bad les pressure and esophagitis? I have a real
concern that I may have all these issues. I've had LPR for so many years
and I lift weights and run, which may have exacerbated the problems.
However, going back to being a couch potato is not a good option for me -
even if it cut down on the reflux. I have other health risks that the
fitness lifestyle helps. I've done the exercising for the past 20 years and
it never caused me an increase in reflux in the past. I actually do it in
moderation - with twenty minute work out sessions, etc. The weights I lift
are no more than 50 or 60 pounds. I still get the mucous coughing sessions
on my days off from exercising.

Lately my reflux seems to be much worse when I lie down - no matter how high
I raise the head of my bed. Sometimes right away and sometimes within hours
of eating I'm coughing up heaps of mucous for another hour. I've cut
everything out of my diet that is known to be a trigger for reflux for me or
anybody else. I've tried everything known to man in the natural cures and
they have not helped. My bed is raised 16 inches. I never lie down within 3
hours of eating, etc. The only thing I do that I can think of that could be
a trigger is the exercising.

I had my lpr under great and consistent control for many years until after a
series of unsuccessful dental procedures a year ago and I've had raging
uncontrollable LPR with severe mucous ever since.

If there are no viable options for me to get this back under control, I do
have concern. With what I know about the meds and the bad experiences I had
the few times I tried them, I am feeling kind of concerned to even risk
going into a stretta doctor to get my esophagus and reflux tested. I don't
know if I could handle finding out there isn't any help for me. I'm hoping
you can tell me if there are other treatment options that I'm unaware of in
case my esophagus is herniated, inflamed, and has low resting pressure
LES. -Blocks to Books

www.blockstobooks.com

jmc

2006-08-05, 2:23 am

Suddenly, without warning, Blocks to Books exclaimed (05-Aug-06 8:44 AM):
> "Howard McCollister" <nospam@nospam.net> wrote in message
> news:44cc9581$0$74490$bb4e3ad8@newscene.com...
>
> I'm a different person from the poster above. I asked you some stretta
> questions prompted by this poster's comments and your response to the
> poster. Thank you for the answers you gave me. I now have one more big
> concern:
>
> If it is found that a person has a large hiatus hernia, low resting LES
> pressure, and esophagitis, does that rule them out completely as a potential
> stretta procedure candidate or does it make any success from the procedure
> extremely unlikely?
>
> Are there any non-proton pump inhibitor treatment options for a person with
> a large hiatal hernia, bad les pressure and esophagitis? I have a real
> concern that I may have all these issues. I've had LPR for so many years
> and I lift weights and run, which may have exacerbated the problems.
> However, going back to being a couch potato is not a good option for me -
> even if it cut down on the reflux. I have other health risks that the
> fitness lifestyle helps. I've done the exercising for the past 20 years and
> it never caused me an increase in reflux in the past. I actually do it in
> moderation - with twenty minute work out sessions, etc. The weights I lift
> are no more than 50 or 60 pounds. I still get the mucous coughing sessions
> on my days off from exercising.
>
> Lately my reflux seems to be much worse when I lie down - no matter how high
> I raise the head of my bed. Sometimes right away and sometimes within hours
> of eating I'm coughing up heaps of mucous for another hour. I've cut
> everything out of my diet that is known to be a trigger for reflux for me or
> anybody else. I've tried everything known to man in the natural cures and
> they have not helped. My bed is raised 16 inches. I never lie down within 3
> hours of eating, etc. The only thing I do that I can think of that could be
> a trigger is the exercising.
>
> I had my lpr under great and consistent control for many years until after a
> series of unsuccessful dental procedures a year ago and I've had raging
> uncontrollable LPR with severe mucous ever since.
>
> If there are no viable options for me to get this back under control, I do
> have concern. With what I know about the meds and the bad experiences I had
> the few times I tried them, I am feeling kind of concerned to even risk
> going into a stretta doctor to get my esophagus and reflux tested. I don't
> know if I could handle finding out there isn't any help for me. I'm hoping
> you can tell me if there are other treatment options that I'm unaware of in
> case my esophagus is herniated, inflamed, and has low resting pressure
> LES. -Blocks to Books
>
> www.blockstobooks.com
>
>

Have you eliminated other possible causes for the productive cough?
There are other things that can cause a cough when lying down -
Bronchitis is one, I think, and I'm sure there are others. I get what
we call my 'french fry cough' - not sure if it's reflux or intolerance,
since I often get a cough after any sort of carb. Though I don't have
one now, and had spaghetti with tomato sauce for lunch. Go figure.

Just wondering. I'm trying to work out many of the same issues, and
since I had some major respiratory illness not so long ago, I don't know
(yet) whether my productive cough is lpr, respiratory, or a food
intolerance, or something else both my doctor and I are missing.

Good luck, and keep us informed as to what you've found out. I do think
it's worth at least getting tested, if your cough's that bad.

jmc

Howard McCollister

2006-08-05, 2:23 am

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:gxQAg.23070$6w.21749@fed1read11...
>
> I'm a different person from the poster above. I asked you some stretta
> questions prompted by this poster's comments and your response to the
> poster. Thank you for the answers you gave me. I now have one more big
> concern:
>
> If it is found that a person has a large hiatus hernia, low resting LES
> pressure, and esophagitis, does that rule them out completely as a
> potential stretta procedure candidate or does it make any success from the
> procedure extremely unlikely?
>
> Are there any non-proton pump inhibitor treatment options for a person
> with a large hiatal hernia, bad les pressure and esophagitis? I have a
> real concern that I may have all these issues. I've had LPR for so many
> years and I lift weights and run, which may have exacerbated the problems.
> However, going back to being a couch potato is not a good option for me -
> even if it cut down on the reflux. I have other health risks that the
> fitness lifestyle helps. I've done the exercising for the past 20 years
> and it never caused me an increase in reflux in the past. I actually do
> it in moderation - with twenty minute work out sessions, etc. The weights
> I lift are no more than 50 or 60 pounds. I still get the mucous coughing
> sessions on my days off from exercising.
>
> Lately my reflux seems to be much worse when I lie down - no matter how
> high I raise the head of my bed. Sometimes right away and sometimes
> within hours of eating I'm coughing up heaps of mucous for another hour.
> I've cut everything out of my diet that is known to be a trigger for
> reflux for me or anybody else. I've tried everything known to man in the
> natural cures and they have not helped. My bed is raised 16 inches. I
> never lie down within 3 hours of eating, etc. The only thing I do that I
> can think of that could be a trigger is the exercising.
>
> I had my lpr under great and consistent control for many years until after
> a series of unsuccessful dental procedures a year ago and I've had raging
> uncontrollable LPR with severe mucous ever since.
>
> If there are no viable options for me to get this back under control, I do
> have concern. With what I know about the meds and the bad experiences I
> had the few times I tried them, I am feeling kind of concerned to even
> risk going into a stretta doctor to get my esophagus and reflux tested. I
> don't know if I could handle finding out there isn't any help for me.
> I'm hoping you can tell me if there are other treatment options that I'm
> unaware of in case my esophagus is herniated, inflamed, and has low
> resting pressure LES. -Blocks to Books
>
> www.blockstobooks.com
>

The major contraindications to Stretta are:

- hiatus hernia larger than 2 cm - this is because the upward displacement
of the LES puts the energy delivery close to the heart. There are surgeons
who will do a Stretta on hiatus hernias as large as 4 cm. I don't, primarily
because I think the success rate is too low in that circumstance.
- pregnancy
-achalasia or incomplete relaxation of the LES on swallowing

Acute erosive esophagits is a contraindication - that erosion/inflammation
needs to be resolved before going ahead with Stretta.
Barrett's esophagus can be a problem because the technique relies on clear
identification of the Z-line to know where the LES is, and the Z-line is
distorted (or absent) in Barrett's esophagus.

Low resting pressure (below 10-12 mmHg) is not a contraindication - it just
lowers the success rate IMHO.

A large hiatus hernia is the most likely deal-breaker you'd need to face. If
it prevented you from getting a Stretta, your only viable anti-reflux
procedure would be a hiatal herniorraphy and Nissen fundoplication. That's a
very successful procedure when done by a competent surgeon on a patient that
has been appropriately worked up.

HMc

Blocks to Books

2006-08-05, 4:24 pm

"jmc" <NOnewsgroupsSPAM@NOjodiBODY.HOMEus> wrote in message
news:4jifu8F7uf4rU1@individual.net...
> Suddenly, without warning, Blocks to Books exclaimed (05-Aug-06 8:44 AM):
>
> Have you eliminated other possible causes for the productive cough? There
> are other things that can cause a cough when lying down - Bronchitis is
> one, I think, and I'm sure there are others. I get what we call my
> 'french fry cough' - not sure if it's reflux or intolerance, since I often
> get a cough after any sort of carb. Though I don't have one now, and had
> spaghetti with tomato sauce for lunch. Go figure.
>
> Just wondering. I'm trying to work out many of the same issues, and since
> I had some major respiratory illness not so long ago, I don't know (yet)
> whether my productive cough is lpr, respiratory, or a food intolerance, or
> something else both my doctor and I are missing.
>
> Good luck, and keep us informed as to what you've found out. I do think
> it's worth at least getting tested, if your cough's that bad.
>
> jmc

I think I probably have bronchitis but I think it might be caused by reflux
being able to aspirate into my lungs since this productive cough began last
year. I think perhaps the epiglottis in my throat has become loose or
mishapen and it might not be sealing as well as it used to so it might allow
the reflux to get into my bronchial tubes. I guess an ent could find this
out, but I'm not sure what, if anything could be done to correct it.

I've become more and more doctor shy the older I get. I'm still trying to
get my nerve up to check out myself as a possible stretta candidate. I wish
I had a "one stop" doc who could do all the necessary testing and check out
my epiglottis function at the same time, but it's unlikely. My major fear
is finding a doctor that will go off in an entirely different direction or
one who won't do all the necessary tests or one who will want to go ahead
with surgery regardless of whether I'm a good candidate or not. I don't
want to have to go from doctor to doctor to try to get the basics of what I
need to make an informed decision.

It's also possible that I've developed some kind of intolerance like you
mention. Because the cough isn't predictable based on what I eat or the
amount I eat, etc. Because I never eat anything that is a known reflux
trigger, it's does present an illogical puzzle to me. I think it's all
coming to a head and I'm going to be forced by my physical symptoms into
trying to solve the mystery.

Once insurance companies took over the supervision of the practice of
medicine in the US, I feel like any doctor I go to is having to practice
medicine blindfolded and with both hands tied behind his or her back. Even
when I tell them I don't have the supervisory type of insurance; they are
becoming habituated to practicing medicine in this manner. Doctors often
have a hard enough time being good diagnosticians as it is. The further
handicap of practicing medicine in a way to please an insurance company's
bottom line makes going to a doctor kind of feel like a crap shoot to me and
then I get too scared to even investigate anything for that reason. Thanks
for your comments though. I appreciate the feedback and will take it into
consideration. -Blocks

Blocks to Books

2006-08-05, 4:24 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:44d40a29$0$74426$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:gxQAg.23070$6w.21749@fed1read11...
>
> The major contraindications to Stretta are:
>
> - hiatus hernia larger than 2 cm - this is because the upward displacement
> of the LES puts the energy delivery close to the heart. There are surgeons
> who will do a Stretta on hiatus hernias as large as 4 cm. I don't,
> primarily because I think the success rate is too low in that
> circumstance.
> - pregnancy
> -achalasia or incomplete relaxation of the LES on swallowing
>
> Acute erosive esophagits is a contraindication - that erosion/inflammation
> needs to be resolved before going ahead with Stretta.
> Barrett's esophagus can be a problem because the technique relies on clear
> identification of the Z-line to know where the LES is, and the Z-line is
> distorted (or absent) in Barrett's esophagus.
>
> Low resting pressure (below 10-12 mmHg) is not a contraindication - it
> just lowers the success rate IMHO.
>
> A large hiatus hernia is the most likely deal-breaker you'd need to face.
> If it prevented you from getting a Stretta, your only viable anti-reflux
> procedure would be a hiatal herniorraphy and Nissen fundoplication. That's
> a very successful procedure when done by a competent surgeon on a patient
> that has been appropriately worked up.
>
> HMc
>
>
>

Thanks for telling me there is an alternative available with a haital repair
and Nissen and exactly what values I should look for when I'm tested to
determine if the chances for success. -Blocks

www.blockstobooks.com

Howard McCollister

2006-08-05, 4:24 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:jo2Bg.23482$6w.20314@fed1read11...
>
>
> I think I probably have bronchitis but I think it might be caused by
> reflux
> being able to aspirate into my lungs since this productive cough began
> last
> year. I think perhaps the epiglottis in my throat has become loose or
> mishapen and it might not be sealing as well as it used to so it might
> allow
> the reflux to get into my bronchial tubes. I guess an ent could find this
> out, but I'm not sure what, if anything could be done to correct it.
>

This "misshapen epiglottis" theory doesn't make sense. The epiglottis
functions to protect the airway during swallowing, not against reflux.

HMc

Blocks to Books

2006-08-05, 9:23 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:44d4d5bc$0$65893$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:jo2Bg.23482$6w.20314@fed1read11...
>
> This "misshapen epiglottis" theory doesn't make sense. The epiglottis
> functions to protect the airway during swallowing, not against reflux.
>
> HMc
>
>
>
>

Thank you for straightening me out. I don't fully understand how reflux is
aspirated, but I think I may have developed this problem. -Blocks

www.blockstobooks.com

Howard McCollister

2006-08-05, 9:23 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:tsaBg.23491$6w.7185@fed1read11...
>
> Thank you for straightening me out. I don't fully understand how reflux
> is
> aspirated, but I think I may have developed this problem. -Blocks
>
> www.blockstobooks.com
>

Microaspiration of gastric refluxate is fairly common and is (hopefully)
becoming increasingly recognized by primary care physicians. It doesn't take
much acid or alkaline reflux to cause hoarseness, coughing, asthma.

HMc